Lung Cancer Flashcards
(79 cards)
1
Q
3 examples of benign tumours in the lungs:
A
- hamartoma
- arterio-venous malformation (AVMs)
- granuloma
2
Q
3 examples of malignant tumours in the lungs:
A
- primary lung cancer
- carcinoid tumour
- Secondary: metastases from breast, colon, kidney, ovaries, prostate, thyroid
3
Q
Bronchiogenic tumours:
- malignant or benign?
- %?
- arises from?
A
- malignant
- accounts for 90% of lung cancers
- arise from the cells of the bronchial mucosa:
- NSCLC (non-small cell lung cancer) arises from the epithelial and glandular cells
- SCLC (small cell lung cancer) arises from neuroendocrine cells
4
Q
Adenocarcinoma in situ (previously called bronchoalveolar cell carcinoma):
- malignant or benign?
- accounts for??
- arises from?
A
- malignant
- accounts for 5% of lung cancers
- arises from alveolar cells
5
Q
Mesothelioma:
- malignant or benign?
- where?
- associated with?
A
- malignant
- tumour of the pleura
- associated with asbestos
6
Q
What is the most common fatal malignancy in men and women in the UK?
A
Lung cancer
7
Q
Lung cancer is the —— most common cause of death in the UK
A
3rd
8
Q
Incidence of lung cancer in the UK?
A
40,000 new cases/year in the UK
9
Q
Mortality from lung cancer in the UK?
A
34,000 deaths/year in the UK
10
Q
Male: Female ratio of lung cancer (reflecting previous smoking habits)?
A
1.5:1
11
Q
What is the leading cause of cancer death in the UK?
A
Lung cancer
women started smoking too in the 60s
12
Q
Lung cancer is the leading cause of cancer deaths in men.
True or False?
A
True
13
Q
Which age range is majority of lung cancers diagnosed between?
A
40-70 years
14
Q
Which of the following is the biggest risk factor for developing lung cancer?
1 = age
2 = asbestos exposure
3 = cigarette smoking
4 = smoking marijuana
5 = smoking and asbestos exposure
together
A
5
15
Q
Aetiology of lung cancer (11) :
A
- cigarette smoking
- passive smoking
- asbestos exposure
- ionising radiation (radon gas)
- polycyclic aromatic hydrocarbons
- vinyl chloride
- arsenic
- nickel
- genetic predisposition (family history): polymorphisms in P450
- idiopathic pulmonary fibrosis (IPF)
- scar carcinoma: tumours can arise from areas of chronic fibrosis
16
Q
Talk about relation of incidence and prevalence of lung cancer
A
- incidence high
- prevalence low
- because many diagnosed, most survived
17
Q
Cigarette smoking and lung cancer
A
- smoking cigarettes is the main risk factor
- cigarette smoke contains carcinogens, which cause genetic mutations
- passive smoking increases risk of lung cancer by 1.5x
- smoking cessation decreases the risk of lung cancer withing the first 5 years after cessation, but remains higher than in a never smoker
- individuals who stop smoking gain 6-10 years of life
- cigar smoking is associated with an increased risk of lung cancer, with a relative risk of 2.1
- pipe smoking also increases the risk of lung cancer with a relative risk of 5
18
Q
Asbestos
A
- latent period of 30-40 years from exposure to development of bronchogenic lung cancer
- asbestos and cigarette smoking act synergistically and increase risk of lung cancer 10x
- asbestos associated with mesothelioma
19
Q
Pathophysiology of bronchogenic lung cancer (5):
A
- carcinogens damage DNA in the bronchial mucosa and cause squamous metaplasia
- Squamous metaplasia: benign, non-cancerous change as a response to irritation and inflammation
- can progress to dysplasia in several areas
- dysplasia: development of abnormal cells within the bronchial mucosa (mild, moderate or severe)
- dysplastic cells then progress to become malignant cells
20
Q
Why does lung cancer present late
A
- most common symptom is persistent cough, lung cancer presents late as it presents with cough but assumed to be smokers cough hence
21
Q
Local invasion of lung cancer:
A
- parenchyma (ipsilateral or contralateral sides)
- pleura
- pericardium
- ribs
- muscle
- nerves (recurrent laryngeal nerve so hoarse voice, phrenic nerve so diaphragmatic ….., sympathetic chain, brachial plexus
- lymph nodes in thorax (hilar, mediastinal, subcarinal)
22
Q
Distal invasion of lung cancer:
A
Lung cancer can spread to:
- lymphatics to lymph nodes outside the thorax mainly subclavicular and cervical
- haematogenous spread to other sites:
- liver
- adrenals
- bones
- brain
- skin
23
Q
Which of the following symptoms will make you worry about lung cancer in a 60 year old man who has been smoking for 45 years
1 = persistent cough
2 = increased shortness of breath
3 = haemoptysis
4 = weight loss
5 = all of the above
A
5
24
Q
Local symptoms of lung cancer (4)(6):
A
- Persistent cough (80%)
- Breathlessness (60%)
- Chest pain (50%)
- Haemoptysis (30%)
- Monophonic wheeze
- Shoulder pain (Pancoast’s tumour causes - - invasion of brachial plexus)
- Hoarse voice (vocal cord palsy secondary
to left recurrent laryngeal nerve palsy) - Superior vena cava (SVC) obstruction (20%)
- Enlarged lymph nodes
- Skin nodules
25
Systemic symptoms of lung cancer:
- weight loss (of muscle)(cachexia leads to
anorexia)
- lethargy
- bone pain
- neurological symptoms: headache, limb
weakness,
peripheral
neuropathy
- spinal cord compression
- paraneoplastic symptoms caused by secretion of hormones or cytokines by SCLC (small cell lung cancer)
26
Signs of lung cancer:
- cachexia (extreme weight loss)
- CLUBBING (20% of non small cell lung cancer)
- hypertrophic pulmonary osteoarthropathy (HPOA) with adenocarcinoma: painful tender swelling of wrists and ankles
- Hoarse voice
- HORNER'S SYNDROME: (meiosis, ptosis, enophthalmos, anhidrosis)
- cervical and supraclavicular lymphadenopathy
- tracheal deviation (upper lobe collapse, pleural effusion)
- SVCO?
- clinical signs of pleural effusion: (↓ chest expansion, ↓breath sounds, dullness on percussion, ↓ TVF and ↓VR)
TVR: tactile vocal resonance
VR: vocal resonance
27
Ptosis
28
image of clubbing
insert
29
Which of these signs seen when you examine a 70 year old woman will make you concerned about lung cancer?
1 = clubbing of fingernails
2 = CO2 retention flap
3 = crackles on auscultation
4 = tar staining of fingernails
5 = raised JVP
1
30
WHO performance status:
0 = able to carry out normal activity
1 = symptomatic but ambulatory and able to
carry out light work
2 = in bed 50% of the day, unable to work
but capable of self-care
3 = in bed >50% of the day, limited self care
4 = bedridden, unable to self-care
31
A 48 year old woman goes to her GP coughing up blood. She has been a heavy smoker since the age of 14. Which investigation should the GP organise immediately?
1 = blood tests for tumour markers
2 = chest X-ray
3 = MRI scan of thorax
4 = spirometry
5 = sputum analysis
2
32
Imaging for suspected lung cancer:
- Chest x-ray: to confirm
- Staging CT thorax and abdomen with contrast: to see stage
- PET scan: to see stage
Maybe:
- Bone scan: to assess bone metastases and pathological fractures
- CT brain: if brain metastases are suspected and prior to radical treatment
- MRI scan of thorax: to assess structural changes prior to surgery
33
Findings of concern on chest x-ray?
- mass]- cavitating lesion
- unilateral pleural effusion
- non-resolving consolidation (pneumonia)
- solitary pulmonary nodule (SPN)
34
Lung lancer
35
insert x ray
insert
36
Why do we order a staging CT of thorax and abdomen with contrast when suspected lung cancer?
- essential for the initial staging of lung cancer
37
CT staging thorax and abdomen: modern scanners detect ------ of what size?
- nodules
- 3-4 nm
38
Contraindications for using iodine when ordering a staging CT thorax and or abdomen:
- renal failure
- allergy to iodine or to previous contrast
39
Insert Ct
insert
40
Insert CT
insert
41
PET scan for lung cancer
- essential for accurate staging of lung cancer
- 18 FDG is taken up by rapidly metabolising cells, including cancer cells
- releases positrons which are detected by a gamma camera
- dual PET/CT scans can correlate the FDG avid areas with the anatomy
42
PET scans are good at detecting distant metastases of lung cancer except and why?
- brain
- brain is always active and taking up glucose
43
What is the sensitivity of PET for lung cancer?
80%
44
What is the specificity of PET for lung cancer?
97%
45
Insert PET scan
FDG avid lesion right upper lobe
46
What blood tests are run for suspected lung cancer?
- full blood count: anaemia, platelet count, clotting
- Urea & Electrolytes: hyponatraemia (low sodium) secondary to syndrome of inappropriate anti-diuretic hormone (SIADH)
- Liver Function Test: may be abnormal with liver metastases
- Hypercalcaemia: (too much calcium) (squamous cell lung cancer) (bone metastases)
47
Why do people with small cell lung cancer present with low sodium?
- hyponatraemia is a common presentation
of lung cancer
- might be due to syndrome of
inappropriate anti-diuretic hormone
- produced by people with small cell lung
cancer
48
Why may a full blood count for lung cancer show anaemia?
tumour growing in bone marrow
49
squamous cell lung cancers lead to hypercalcaemia as
squamous cell lung cancers (non-small cell) secrete pth (parathyroid hormone)
50
Bone metastases of lung cancer can lead to
hypercalcaemia
51
What is ectopic secretion of a hormone?
when a hormone is secreted out of its normal physiological mechanism
52
Ectopic secretion of hormones in lung cancer Paraneoplastic Syndrome:
- small cell lung cancer arises from Kulchitsky neuroendocrine cells of teh "amine uptake and decarboxylation (APUD) system"
- syndrome of inappropriate anti-diuretic hormone (ADH) secretion can lead to hyponatraemia
- parathyroid hormone (PTH) (squamous cell not small cell lung cancer) related peptide can lead to hypercalcaemia
- adrenocortioctrophic hormone (ACTH) can lead to raised cortisol levels (cushing's syndrome)
53
Pulmonary function test for suspected lung cancer
- most patients with lung cancer have COPD
- FEV1, FVC, FEV1/FVC and TLCO required:
- prior to obtaining a CT guided lung
biopsy
- prior to considering surgery or
radiotherapy
- because if they have borderline lung function then will not survive even a biopsy
- ECG
- echocardiogramm
54
Histological diagnoses of lung cancer (9)
- bronchoscopy and biopsy (if central tumour)
- endobronchial ultrasound guided biopsy
- transbronchial needle aspiration of lymph nodes (TBNA)
- CT guided lung biopsy
- ultrasound guided lung biopsy
- fine needle aspiration (FNA) of lymph nodes in the neck
- pleural aspiration from malignant pleural effusion
- any other site with metastases: liver, bone, adrenal
- sputum cytology
55
Risks of invasive procedures for lung cancer diagnosis:
- consider fitness
- consider lung function
56
Risks of biopsy for diagnosis of lung cancer:
- bleeding
- pneumothorax if borderline lung function
57
Insert bronchoscopy: where is the tumour?
insert
58
CT guided biopsy
insert
59
What % of bronchogenic cancers are Non-small cell lung cancer?
80%
60
5 examples of non-small cell lung cancer
- squamous cell lung cancer
- adenocarcinoma
- large cell lung cancer
- malignant carcinoid
- mixed
61
Squamous cell lung cancer arises from
squamous epithelial cells
62
Adenocarcinoma arises from
mucin producing glandular epithelium
63
Large cell lung cancer arises from
undifferentiated cells
64
Does small cell lung cancer have a better prognosis than non-small cells lung cancer?
No
65
What has improved treatment options (immunotherapy) and improved survival in recent years for lung cancers?
molecular mutation testing
66
Small cell lung cancer main facts (5):
- arises from neuroendocrine cells
- produces hormones (ADH)
- has usually metastasized on presentation
- very aggressive
- poor prognosis
67
Staging of lung cancer uses ----- classification?
TMN
T = tumour size T0,T1-T4
N = nodal metastases N0-N3
M = distant metastases M0-M1
68
Management of lung cancer:
- histology of lung cancer
- staging of the cancer TNM
- WHO performance status
- Lung function
- co-morbidities
- wishes of the patient
- MDT decision
- Radical: Surgery, radiotherapy
- Palliative: chemo, immuno, radiotherapy, symptom control
69
medical oncologists give ----- clinical oncologists give
medical oncologists give chemotherapy
clinical oncologists give radiotherapy
70
What is radical treatment for lung cancer aimed at?
curing the patient
71
What is palliative treatment for lung cancer aimed at?
Easing symptoms
72
Management of non-small cell lung cancer
- surgery
- lobectomy (removal of a lung lobe)
- pneumonectomy (removal of one lung)
- wedge resection or segmentectomy (part of lobe)
- radiotherapy (radical)
- chemotherapy
- immunotherapy
- palliative care
73
Management of small cell lung cancer
- unlikely to offer radical treatment as metastases
- chemotherapy
- immunotherapy
- palliative chemotherapy
- palliative radiotherapy
74
Immunotherapy for lung cancer:
- cancer cells have an over expression of certain receptors
- drugs target these proteins
- EGFR: epithelial growth factor receptor mutation
- VEGF Vascular Endothelial Growth Factor receptor
- checkpoint inhibitors
75
What is the most common acquired lung cancer mutation?
EGFR
epithelial growth factor receptor
76
1 year survival in lung cancer % in men and women?
Men: 30%
Women: 35%
77
% for 5 year survival of lung cancer?
9.5%
78
5 Preventions of lung cancer:
- smoking cessation
- reduce exposure to passive smoking exposure
- reduced exposure to radiation
- legislation in the workplace: ban asbestos, reduce exposure to coal dust
- good nutrition
79
Early detection of lung cancer:
- education of patients re symptoms and early review by doctor
- education of healthcare professionals re early symptoms and signs
- early chest x ray
- low does CT screening: groups at risk
